As yet another coronavirus spreads around the globe, scientists are once again trying to develop new treatments and vaccines. Much remains unknown about this family of viruses. But we know that this is the third time in the last twenty years that a coronavirus has made the leap from animals to humans—severe acute respiratory syndrome (SARS) coronavirus in 2002, Middle East respiratory syndrome (MERS) coronavirus in 2012, and the novel coronavirus in 2019. There are no proven treatments and vaccines effective against coronaviruses.
The latest “race” to develop new treatments and vaccines against coronavirus disease 2019 (COVID-19) highlights the critical importance of government-funded research. Since the SARS outbreak, the National Institutes of Health (NIH) alone has spent nearly $700 million on coronavirus R&D.
Table 1 – NIH Coronavirus Funding by Type of Organization, FY 2003 – 2020
|Domestic Higher Education (Cumulative)||336,240,501|
|Organized Research Units||1,814,386|
|Other Domestic Non-Profits||6,271,075|
The NIH has played a singular role. The pharmaceutical industry, meanwhile, has broadly claimed that that the monopoly-based patent system “is the most effective tool to reward and incentivize innovation” and that it “fulfills the promise of breakthroughs in treatments and cures for . . . scores of debilitating or life-threatening illnesses around the world.” Yet the monopoly model has not driven significant industry investment in infectious diseases, including coronaviruses.  Consider the industry pipeline for coronaviruses like SARS and MERS before the latest outbreak.
Table 2 – Active Coronavirus Industry Pipeline Before COVID-19 Outbreak
|Stage||Coronavirus (including SARS and MERS)|
|Research and preclinical||10|
|Marketing and registration||0|
Last year, there were only six active coronavirus clinical trials involving pharmaceutical companies. All of them depended crucially on public funding. Emerging viruses, like the latest coronavirus, pose complex new scientific challenges. But more sustained interest in coronaviruses could have provided greater scientific understanding, and a stronger toolkit to inform the latest response. For example, new antiviral treatments could have offered a promising pool of candidates for COVID-19 clinical trials. In addition, more platform technologies used to develop new vaccines could have been developed and tested.
Table 3 – Active Coronavirus Clinical Trials Involving Pharmaceutical Companies before COVID-19 Outbreak
|NTM 1634||Dana Farber Cancer Institute, Harvard Medical School and University of California at San Francisco||Ology Bioservices||NIH||Phase I|
|REGN 3048||Regeneron Pharmaceuticals||NIH, Regeneron Pharmaceuticals||NIH, BARDA||Phase I|
|REGN 3051||Regeneron Pharmaceuticals||NIH, Regeneron Pharmaceuticals||NIH, BARDA||Phase I|
|MERS coronavirus vaccine||Korea Investment Partners, Vaccitech||University of Oxford, Vaccitech||U.K Dept. of Health, CEPI ||Phase I|
|MERS coronavirus vaccine||Inovio Pharmaceuticals||Inovio Pharmaceuticals
|DoD, CEPI||Phase I|
|MVA MERS S||German Center of Infection Research||IDT Biologika, German Center of Infection Research||CEPI, German Center of Infection Research ||Phase I|
After the latest coronavirus outbreak, many companies announced new vaccine and therapeutic programs. One biotech investor issued a cautionary note: “There’s two things that biotech companies, especially small ones, are always looking for: Attention and cash. And, sadly, a lot of them take advantage of situations…putting out a press release saying they are working on something and you see their stocks zoom.” As of February 5, there were at least 25 different vaccine and treatment efforts for COVID-19—two-thirds with support from nonprofit and public institutions. Despite its significant support, the U.S. government has so far imposed no conditions for safeguarding affordable access.
The public sector has helped drive the COVID-19 response. We cannot rely on industry’s monopoly model to deliver the medicines we need.
Table 4 – New Development Programs for COVID-19
|Originator||Technology||Public and Private Nonprofit Support|
|AbbVie Inc.||Repurposing lopinavir/ritonavir||NIH, Tongji Medical College, Huazhong University of Science and Technology|
|Gilead Sciences Inc.||Repurposing remdesivir||NIH,China Academy of Sciences|
|Johnson & Johnson||Vaccine||BARDA|
|Johnson & Johnson||Repurposing darunavir/cobicistat||Wuhan University|
|AbCellera Biologics||Treatment||DoD, NIH|
|Ascletis Pharma Inc||Repurposing ASC09/ritonavir||NIH|
|GeoVax Labs and BravoVax||Vaccine|
|Inovio Pharmaceuticals||Vaccine||CEPI, DoD|
|Novavax||Vaccine||Gates Foundation, PATH|
|Sichuan Clover Biopharmaceuticals||Vaccine|
|Sorrento Therapeutics and Celularity||Treatment|
|Vir Biotechnology||Treatment||Gates Foundation|
|Academic Institutions and Foundations|
|Baylor College of Medicine,
University of Texas,
New York Blood Center, Fudan University
|National Institutes of Health||Treatment||NIH|
|Pasteur Institute Foundation||Vaccine|
|Stermirna Therapeutics and Tongji University||Vaccine|
|University of Queensland||Vaccine||Government of Australia, CEPI|
|University of Saskatchewan||Vaccine||Government of Canada|
Under the existing monopoly model, the government attempts to incentivize private sector investment by providing patent monopolies. These monopolies allow drug corporations, in theory, to make a reasonable return on their R&D investment. In practice, the system works very differently. In addition to minimizing the role of taxpayer investments, monopolies provide incentives for corporations to set exorbitant launch prices, to use dubious tactics to delay competition, and to spend tens of billions of dollars to aggressively and inappropriately market products.
Another pernicious effect is that pharmaceutical companies overwhelmingly invest in research and development (R&D) for treatments that hold the promise of extravagant returns, not necessarily those that meet critical health needs. As one analyst notes, “The possibility for blockbuster sales motivates large drugmakers; little else moves the needle.”
Private sector R&D is consequently heavily directed towards medicines for chronic conditions and rare diseases. Cancer medicines, in particular, are an attractive target because they command extraordinarily high prices, even if they sometimes offer marginal or no therapeutic improvements compared to existing treatments. The average price of a new cancer medicine is $149,000 per year. According to Bloomberg Intelligence, last summer there were 195 new chemical entities for cancer in Big Pharma pipelines, more than any other disease area.
Private sector R&D largely neglects less lucrative health needs such as vaccines and treatments for infectious diseases. The same analysis found just 65 new chemical entities for infectious diseases and vaccines in the pipeline. Out of the 20 largest pharmaceutical companies, only four have major vaccine programs. One of the remaining vaccine producers, GSK, has decided to curtail its epidemic response work. A senior executive noted, “We do not want to have these activities compete with in-house programs. And our learnings from Ebola, from pandemic flu, from SARS previously, is that it’s very disruptive and that’s not the way that we want to do business going forward.”
After the COVID-19 outbreak, a Johnson & Johnson (J&J) executive explained his company’s decision to invest in research and development by saying “You have to be brave and you have to be a solid company to do this, because there is no real incentive to do this, no financial incentive.”
Yet what is remarkable about this statement—and this story—is what it leaves out. J&J brought in $82 billion in revenue last year, making it larger than the economy of countries like Guatemala and Croatia. The Government Accountability Office found that the top 25 largest pharmaceutical companies, including J&J, were on average more than twice as profitable as the largest 500 companies. In other words, there is an immense amount of money sloshing around the system. But is it paying for what we need?
In 2014, as the Ebola epidemic raged on, a promising vaccine sat on the shelf. The small company that licensed the vaccine from the Canadian government for approximately $200,000 had failed to complete basic safety trials. It was only after the company further sub-licensed the vaccine to Merck for $50 million that it was finally made available through clinical trials. The process took over a year, producing a substantial profit for the small company.
Experts responded by calling for a global mechanism to expedite vaccine development. Several governments and foundations eventually banded together to form the Coalition for Epidemic Preparedness Innovations (CEPI).
CEPI describes itself as filling “a number of critical gaps” in vaccine funding. It has pumped millions of dollars into R&D for emerging infectious diseases, including recently for the COVID-19 response. By funding at least four new vaccine projects, CEPI has jumpstarted efforts to contain the epidemic. But the coalition has also been the subject of criticism. Médecins Sans Frontières recently chastised the coalition’s new access policy, including its failure to “ensure [that] CEPI-funded vaccines will be affordable for people who need them most.”
At its core, CEPI has a limited mandate. This narrow focus on patching up a single market failure overlooks the government’s role in structuring the market itself. The failure to develop vaccines, after all, is only the latest illustration of the limits of the monopoly-based model. Consider industry’s failure to deliver new antibiotics—a critically important public health need. A report commissioned by the U.K. Prime Minister found that drug-resistant bacteria could kill 10 million people a year by 2050. Many major pharmaceutical companies have “waved the white flag” and ended research into new antibiotics, including Novartis, Allergan, AstraZeneca and Sanofi. Or consider the outcry when a Goldman Sachs analyst publicly asked “Is curing patients a sustainable business model?”
We need a system that prioritizes public health. For more than a decade, academics, economists and activists have proposed developing alternative models to incentivize R&D that do not rely on monopolies. In 2016, the United Nations High-Level Panel on Access to Medicines recommended a mechanism to “delink the costs of research and development from end prices to promote access to good health for all.” The idea now enjoys a wide range of support—from the libertarian CATO institute, to the center-left U.K. Labour Party.
The COVID-19 crisis highlights the urgent need for a new model. We should have dedicated funding and an established research infrastructure to quickly develop drugs and vaccines. For example, the government could take a greater role in full-cycle drug development by creating a new pharmaceutical research and development institute. One approach could involve the government directly conducting the research and development of treatments and vaccines, and either manufacturing the products or issuing open licenses for generic production. Another approach could involve using grants and cash prizes—instead of the promise of monopolies—to incentivize drug development for important public health needs. By delinking the price of the drug from its cost of development, the government could help deliver the products we need at a price we can afford.
We already have a blueprint in place for an approach that prioritizes public health. The U.S. government engages in transformative work, increasingly through the later stages of development. Indeed, the coronavirus example shows how deeply the pharmaceutical industry depends on public investment. Since the SARS outbreak, the National Institutes of Health alone has spent nearly $700 million on coronavirus R&D.
The coronavirus funding is a sliver of the $41 billion the NIH now invests annually. In the past twenty years, the NIH has spent more than a half trillion dollars. This helps drive innovation. Research funded by the National Institutes of Health contributed in part to every one of the 210 new drugs approved by the Food and Drug Administration (FDA) from 2010–2016. In addition, a quarter of small-molecule drugs approved over the last decade had key late stage research contributions from public sector research institutions and related private spin-offs.
Implementing an approach that looks beyond monopolies could help ensure that taxpayers do not pay twice. U.S. taxpayers are compensated for their significant investment in biomedical research and development by being charged the highest medicine prices in the world.
Consider the case of Regeneron. On February 4th 2020, the Biomedical Advanced Research and Development Authority (BARDA) of the Department of Health and Human Services announced it would partner with the biotech company to develop antibody treatments for COVID-19. Under a general agreement signed in 2017, BARDA agreed to pay 80% of R&D and manufacturing costs for the antibodies it selected to target pathogens. A year earlier, another arrangement specific to a MERS treatment went as far as to pay up to $8.9 million to:
support packaging and labeling of the antibodies for human use, the preparation and submission of an Investigational New Drug application with the U.S. Food and Drug Administration (FDA), and a National Institutes of Health-conducted clinical trial in healthy volunteers.
The government has provided the corporation enormous support in drug development. Regeneron, unlike so many other companies, has not turned away from infectious diseases. Yet despite providing crucial support, the government has attached no conditions on affordability, which means the company will be able to gain a monopoly to charge whatever the market will bear for a drug that taxpayers helped develop. The government subsidies are particularly remarkable given the fact that the two executives at Regeneron are the two highest paid executives in the entire pharmaceutical industry, having brought in more than $200 million together just in 2018. Since 2012, Regeneron’s executive compensation has doubled.
As we move towards a better alternative, a minimum first step should be to require conditions to safeguard affordable global access in all COVID-19 government grants, contracts, and licensing arrangements. This should include prohibiting exclusive licenses on government-funded inventions. If the government nonetheless grants an exclusive license, it should ensure that the scope of rights is not broader than reasonably necessary to induce the investment needed to commercialize the technology, and ensure reasonable pricing.
David Quammen, an author, wrote last month that “We must remember, when the dust settles, that [the new coronavirus] was not a novel event or a misfortune that befell us. It was—it is—part of a pattern of choices that we humans are making.” One choice that determines how this virus, and others like it in the future, will spread is how we structure our institutions for innovation. The current monopoly-based model prioritizes short-term corporate profits over public health. A new approach could help make the medicines we need for a price that we can afford.
Table 1 – NIH Funding Related to Coronaviruses Since SARS Outbreak (source: NIH Reporter)
Methodology: We searched for “coronavirus” in the NIH RePORTER database on February 6th. The search produced 1730 results. We reviewed all hits to make sure that the projects were related to R&D for coronaviruses, and excluded all hits before FY 2003 (i.e., the emergence of SARS). We included all projects that had at least some funding for coronavirus R&D. We excluded indirectly related projects, such as those purely tracing the epidemiology of coronaviruses. We also counted subprojects that were not included in other main projects. The full dataset is available on request.
|Organization Name||Total Funding||Distinct Projects|
|AARON DIAMOND AIDS RESEARCH CENTER||1247415||1|
|AKONNI BIOSYSTEMS, INC.||890768||2|
|ARIZONA STATE UNIVERSITY-TEMPE CAMPUS||1992975||4|
|AUTOIMMUNE TECHNOLOGIES, LLC||225000||1|
|BAYLOR COLLEGE OF MEDICINE||6109110||2|
|BIOFIRE DEFENSE, LLC.||715172||1|
|BIOFIRE DIAGNOSTICS, INC.||1346410||1|
|BOISE TECHNOLOGY, INC.||237248||1|
|BOSTON CHILDREN’S HOSPITAL||1921321||1|
|BRIGHAM AND WOMEN’S HOSPITAL||136008||1|
|CANTONAL HOSPITAL ST GALLEN||247063||1|
|CASE WESTERN RESERVE UNIVERSITY||647510||1|
|CLEVELAND CLINIC LERNER COM-CWRU||3225451||2|
|COLORADO STATE UNIVERSITY||85585||1|
|COLUMBIA UNIVERSITY HEALTH SCIENCES||7715325||2|
|CROSSLIFE TECHNOLOGIES, INC.||299766||1|
|DANA-FARBER CANCER INST||6828176||2|
|DYNPORT VACCINE COMPANY, LLC||1774468||1|
|ECOHEALTH ALLIANCE, INC.||1201431||2|
|FRED HUTCHINSON CAN RES CTR||615972||1|
|FRED HUTCHINSON CANCER RESEARCH CENTER||1826838||3|
|HARVARD MEDICAL SCHOOL||7499601||4|
|HARVARD UNIVERSITY (MEDICAL SCHOOL)||1085757||2|
|ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI||1592528||3|
|INDIANA UNIVERSITY BLOOMINGTON||1808242||1|
|INSTITUTE FOR GENOMIC RESEARCH||93020||1|
|INSTITUTE OF MATERIA MEDICA||1060038||1|
|INTERNATIONAL AIDS VACCINE INITIATIVE||1297428||1|
|IOWA STATE UNIVERSITY||1090241||1|
|J. CRAIG VENTER INSTITUTE, INC.||4506896||1|
|JOHNS HOPKINS UNIVERSITY||5009136||7|
|KANSAS STATE UNIVERSITY||1826890||2|
|LEIDOS BIOMEDICAL RESEARCH, INC.||72410171||1|
|LOUISIANA STATE UNIV A&M COL BATON ROUGE||40397||1|
|LOVELACE BIOMEDICAL & ENVIRONMENTAL RES||6299244||2|
|LOYOLA UNIVERSITY CHICAGO||9926573||5|
|MASSACHUSETTS GENERAL HOSP||638451||1|
|MEDICAL COLLEGE OF WISCONSIN||8417066||2|
|MICROBIAL NOVOTEQS, INC.||1200548||1|
|MONTANA STATE UNIVERSITY – BOZEMAN||1069167||1|
|NATIONAL INSTITUTES OF HEALTH||184444883||19|
|NEW YORK BLOOD CENTER||9146571||6|
|NOVARTIS VACCINES AND DIAGNOSTICS, INC.||10427728||1|
|OHIO STATE UNIVERSITY||2751713||2|
|OREGON HEALTH & SCIENCE UNIVERSITY||10299899||1|
|OREGON STATE UNIVERSITY||178510||1|
|PASTEUR INSTITUTE FROM MADAGASCAR||134900||1|
|PHELIX THERAPEUTICS, LLC||4382085||1|
|PLANET BIOTECHNOLOGY, INC.||2036730||2|
|PROTEIN SCIENCES CORPORATION||37549||1|
|PUBLIC HEALTH ENGLAND||375261||1|
|PURDUE UNIVERSITY WEST LAFAYETTE||501158||2|
|RBHS-NEW JERSEY MEDICAL SCHOOL||5784707||1|
|RESEARCH INST OF FOX CHASE CAN CTR||223125||1|
|RIDGEWAY BIOSYSTEMS, INC.||189967||1|
|SCRIPPS RESEARCH INSTITUTE||2096393||5|
|SEATTLE BIOMEDICAL RESEARCH INSTITUTE||455046||1|
|SOUTHERN RESEARCH INSTITUTE||145380||1|
|ST. LOUIS VA MEDICAL CENTER||UNAVAILABLE||1|
|STATE UNIVERSITY NEW YORK STONY BROOK||409500||1|
|STATE UNIVERSITY OF NEW YORK AT BUFFALO||426957||1|
|TEXAS A&M UNIVERSITY||928034||2|
|TEXAS A&M UNIVERSITY HEALTH SCIENCE CTR||992168||3|
|THOMAS JEFFERSON UNIVERSITY||468000||1|
|TRUDEAU INSTITUTE, INC.||1724320||1|
|TULANE UNIVERSITY OF LOUISIANA||91681||1|
|UNITED BIOMEDICAL, INC.||1565264||1|
|UNIV OF ARKANSAS FOR MED SCIS||1646917||1|
|UNIV OF MARYLAND, COLLEGE PARK||1543072||2|
|UNIV OF MASSACHUSETTS MED SCH WORCESTER||3397728||2|
|UNIV OF NORTH CAROLINA CHAPEL HILL||64129175||16|
|UNIVERSITY OF ALABAMA AT BIRMINGHAM||43357565||3|
|UNIVERSITY OF ALBERTA||536632||1|
|UNIVERSITY OF ARKANSAS MED SCIS LTL ROCK||2501212||2|
|UNIVERSITY OF CALIF-LAWRNC LVRMR NAT LAB||1166241||1|
|UNIVERSITY OF CALIFORNIA||701575||1|
|UNIVERSITY OF CALIFORNIA RIVERSIDE||488988||1|
|UNIVERSITY OF CALIFORNIA SAN FRANCISCO||28985||1|
|UNIVERSITY OF CALIFORNIA, SAN DIEGO||2167754||1|
|UNIVERSITY OF CALIFORNIA, SAN FRANCISCO||902982||2|
|UNIVERSITY OF CALIFORNIA-IRVINE||535318||1|
|UNIVERSITY OF CINCINNATI||1016093||1|
|UNIVERSITY OF COLORADO||427504||1|
|UNIVERSITY OF COLORADO DENVER||10881621||6|
|UNIVERSITY OF FLORIDA||1458409||1|
|UNIVERSITY OF GEORGIA||416969||1|
|UNIVERSITY OF IDAHO||307575||1|
|UNIVERSITY OF ILLINOIS||1831732||2|
|UNIVERSITY OF ILLINOIS AT CHICAGO||5648691||4|
|UNIVERSITY OF IOWA||15472766||8|
|UNIVERSITY OF KANSAS LAWRENCE||309202||2|
|UNIVERSITY OF MARYLAND BALT CO CAMPUS||216567||1|
|UNIVERSITY OF MARYLAND BALTIMORE||9808891||9|
|UNIVERSITY OF MARYLAND COLLEGE PK CAMPUS||386308||1|
|UNIVERSITY OF MICHIGAN AT ANN ARBOR||1140979||1|
|UNIVERSITY OF MINNESOTA||3679265||1|
|UNIVERSITY OF MISSOURI-COLUMBIA||392973||1|
|UNIVERSITY OF NEW MEXICO||437155||2|
|UNIVERSITY OF NORTH CAROLINA CHAPEL HILL||4390880||3|
|UNIVERSITY OF PENNSYLVANIA||14574842||13|
|UNIVERSITY OF PITTSBURGH AT PITTSBURGH||381629||1|
|UNIVERSITY OF ROCHESTER||1364134||1|
|UNIVERSITY OF SOUTH DAKOTA||76421||1|
|UNIVERSITY OF SOUTHAMPTON||1038748||1|
|UNIVERSITY OF SOUTHERN CALIFORNIA||650000||1|
|UNIVERSITY OF TENNESSEE HEALTH SCI CTR||190000||1|
|UNIVERSITY OF TENNESSEE KNOXVILLE||3179414||1|
|UNIVERSITY OF TEXAS EL PASO||994098||2|
|UNIVERSITY OF TEXAS MED BR GALVESTON||12331514||8|
|UNIVERSITY OF TEXAS MEDICAL BR GALVESTON||1823872||3|
|UNIVERSITY OF TEXAS, AUSTIN||1240189||1|
|UNIVERSITY OF TOLEDO HEALTH SCI CAMPUS||1082056||1|
|UNIVERSITY OF UTAH||1260978||1|
|UNIVERSITY OF VIRGINIA||5735502||3|
|UNIVERSITY OF WASHINGTON||3501555||4|
|UNIVERSITY OF WISCONSIN-MADISON||838413||2|
|UT SOUTHWESTERN MEDICAL CENTER||266250||1|
|UTAH STATE UNIVERSITY||811338||1|
|VANDERBILT UNIVERSITY MED CTR||653691||3|
|VANDERBILT UNIVERSITY MEDICAL CENTER||2555159||3|
Table 2 – Coronavirus Projects by Pharmaceutical Companies before COVID-19 Outbreak (source: World Health Organization via AdisInsight).
Methodology: We primarily relied on the World Health Organization’s Global Observatory on Health R&D, which draws from the commercial AdisInsight database. We compiled data for treatments and vaccines under the “SARS,” “MERS,” and “coronavirus (unspecified)” categories. The database includes projects that have at least one commercial developer.
|Active Projects before COVID-19 Outbreak|
|GS-5734||Gilead Sciences||Gilead Sciences, National Institute of Allergy and Infectious Diseases||Preclinical|
|NTM 1634||Dana Farber Cancer Institute, Harvard Medical School and University of California at San Francisco||Ology Bioservices||Phase I|
|REGN 3048||Regeneron Pharmaceuticals||National Institute of Allergy and Infectious Diseases, Regeneron Pharmaceuticals||Phase I|
|REGN 3051||Regeneron Pharmaceuticals||National Institute of Allergy and Infectious Diseases, Regeneron Pharmaceuticals||Phase I|
|Research program: viral therapeutics||Genekam Biotechnology||Research|
|Research program: severe acute respiratory syndrome-coronavirus 3CL protease inhibitors||Microbial Novoteqs||Microbial Novoteqs||Research|
|Research program: severe acute respiratory syndrome-coronavirus PL protease inhibitors||Microbial Novoteqs||Microbial Novoteqs||Research|
|Research program: adenosine A3 antagonists||Future Medicine||Future Medicine||Preclinical|
|Rintatolimod||Hemispherx Biopharma||AIM ImmunoTech||Research|
|Middle East respiratory syndrome coronavirus vaccine||Korea Investment Partners, Vaccitech||University of Oxford, Vaccitech||Phase I|
|Middle East respiratory syndrome coronavirus vaccine (intradermal)||Inovio Pharmaceuticals||Inovio Pharmaceuticals, Walter Reed Army Institute of Research||Phase I|
|MVA MERS S||German Center of Infection Research||IDT Biologika, German Center of Infection Research||Phase I|
|Research program: DNA vaccines||Greffex Inc||Greffex Inc||Preclinical|
|Research program: infectious disease vaccines||Themis Bioscience||Themis Bioscience||Preclinical|
|Research program: viral infection vaccines||Protein Potential||Protein Potential||Preclinical|
|Inactive Projects before COVID-19 Outbreak|
|AMZ 0026||Advanced Plant Pharmaceuticals||Amazon Biotech||Discontinued|
|BG 777||Virocell||No Development
|CEL 1000||CEL-SCI Corporation||United States Medical Institute of Infectious Diseases||No Development
|CRV 431||Isotechnika||Hepion Pharmaceuticals||Discontinued|
|Galidesivir||BioCryst Pharmaceuticals||BioCryst Pharmaceuticals||No Development
|Interferon alfacon-1||Amgen||Astellas Pharma, Three Rivers Pharmaceuticals||Discontinued|
|Interferon-alpha-n3||Stem Cell Innovations||AIM-Immunotech||No Development
|Research program: anti-coronavirus monoclonal antibodies||Medarex, University of Massachusetts Medical School||Discontinued|
|Research program: antiviral and anticancer ribonucleases||Alfacell Corporation||National Institute of Allergy and Infectious Diseases, Tamir Biotechnology||No Development
|Research program: antivirals||Biota Holdings||Biota Holdings, National Institute of Allergy and Infectious Diseases, United States Army Medical Research Institute of Infectious Diseases||Discontinued|
|Research program: biodefence antibodies||Dana Farber Cancer Institute, Harvard Medical School, University of California at San Francisco||XOMA||No Development
|Research program: biodefence vaccines||GenPhar||No Development
|Research program: coronavirus antisense therapy||Isis Pharmaceutical||No Development
|Research program: coronavirus inhibitors||EpiCept Cororation||Immune Pharmaceuticals Inc, National Institute of Allergy and Infectious Diseases||Discontinued|
|Research program: coronavirus inhibitors||Fulcrum Pharmaceuticals, John Hopkins University||Discontinued|
|Research program: coronavirus inhibitors||Kucera||No Development
|Research program: coronavirus inhibitors||TaiGen||No Development
|Research program: coronavirus inhibitors||United States Army Medical Research Institute of Infectious Diseases, ViroPharma||United States Army Medical Research Institute of Infectious Diseases, ViroPharma||Discontinued|
|Research program: dipiperidine anti-infectives/anti-inflammatories||Sequella||Sequella||No Development
|Research program: Middle East respiratory syndrome coronavirus nanoparticle therapies||Nanoviricides||Lovelace Respiratory Research-Institute, Nanoviricides||Discontinued|
|Research program: monoclonal antibodies||Humabs Biomed||Humabs Biomed||No Development
|Research program: peptide-based viral entry inhibitors||Autoimmune Technologies, Tulane University School of Medicine||Autoimmune Technologies, Tulane University School of Medicine||No Development
|Research program: polyclonal immunoglobulins||Fabentech||Fabentech||No Development
|Research program: SARS therapies||Pfizer||Pfizer||No Development
|Research program: SARS-coronavirus antibodies||Diversa||Diversa||No Development
|Research program: SeV-based gene therapies||DNAVEC Corporation||ID-Pharma||No Development
|Research program: short interfering RNA-based therapeutics||Intradigm Corporation||Intradigm Corporation||Discontinued|
|Research program: small-molecule antivirals||Kemin Phama||United States Medical Army Institute of Infectious Disease||Discontinued|
|Research program: therapeutic agents||Pharmagenesis||Pharmagenesis||No Development
|Research program: viral budding inhibitors||Biotron||Biotron||No Development
|Research program: viral immunotherapy||Lipid Sciences||No Development
|Research program: viral infection therapies||Quigley Pharma||Quigley Pharma||No Development
|SAB 301||SAB Biotherapeutics||SAB Biotherapeutics, National Institutes of Health||No Development
|SARS virus hyperimmune globulin||Cangene Corporation||Discontinued|
|Ulinastitin||Techpool Bio-Pharma||Techpool Bio-Pharma||No Development
|Coronavirus vaccine||Beijing Kexing Bioproduct Co||No Development
|Coronavirus vaccine||Berna Biotech||Berna Biotech||Discontinued|
|Coronavirus vaccine||GlaxoSmithKline, Institut Paseur||No Development
|Coronavirus vaccine||ID Biomedical Corporation||ID Biomedical Corporation||No Development
|Coronavirus vaccine||Sanofi Pasteur||Sanofi Pasteur, NIAID||Discontinued|
|Coronavirus vaccines||Baylor College of Medicine, Sabin Vaccine Institute||Brighton Biotech, Baylor College of Medicine, Sabin Vaccine Institute, Texas Children’s Hospital for Vaccine Development||No Development
|Middle East respiratory syndrome coronavirus vaccine (intramuscular)||GeneOne Life Sciences, Inovio Pharmaceuticals||GeneOne Life Sciences, Inovio Pharmaceuticals||No Development
|Middle-East respiratory syndrome coronavirus vaccine||National Institute of Health, Organic Vaccines||Organic Vaccines||No Development
|Research program: coronavirus vaccine||Baxter Healthcare Corporation||Baxter Healthcare Corporation||No Development
|Research program: coronavirus vaccines||Novavax||Novavax||Discontinued|
|Research program: coronavirus vaccines||Antigen Express, Generex Biotechnology Corporation||No Development
|Research program: MERS vaccines||Replikins||Replikins||No Development
|Research program: SARS-coronavirus vaccine||Alphavax||Alphavax||No Development
|Severe acute respiratory syndrome vaccine||Protein Sciences Corporation||Protein Sciences Corporation||No Development
|VRC-SRSDNA015-00-VP||NIH Vaccine Research Center||No Development
This data and/or information was obtained from the World Health Organization (WHO) Global Observatory on Health R&D (the Observatory), located at http://www.who.int/research-observatory/en/. In this case, the data used originates from the following source(s): Springer AdisInsight database, https://adisinsight.springer.com/. WHO does not guarantee or make any express or implied representations regarding this data and/or information, including with respect to its accuracy, reliability, correctness, or fitness for use for a particular purpose. Unless otherwise specified on the Observatory Website, Observatory Data originates from a source external to WHO. All rights, including copyright, in Observatory Data rest with their respective owner(s), per the attribution provided on the Observatory Website.
 Stanley Perlman, Another Decade, Another Coronavirus, New England Journal of Medicine (Jan. 24 2020), https://www.nejm.org/doi/full/10.1056/NEJMe2001126. National Institute of Allergy and Infectious Diseases, Coronaviruses (Jan. 31 2020), https://tinyurl.com/u37y25u (“Coronaviruses are a large family of viruses that usually cause mild to moderate upper-respiratory tract illnesses, like the common cold, in people. However, three times in the 21st century coronavirus outbreaks have emerged from animal reservoirs to cause severe disease and global transmission concerns.)”
 Data is from National Institutes of Health Reporter. See Appendix, table 1 for methodology and additional data. This figure excludes funding by the U.S. Department of Defense, the Biomedical Advanced Research and Development Authority (BARDA) of the U.S. Department of Health and Human Services, and other global funders.
 Mark Grayson, 5 Reasons why biopharmaceutical patents are different, PhRMA (Sept 10. 2015), https://catalyst.phrma.org/5-reasons-why-biopharmaceutical-patents-are-different
 See A Question of Priorities.
 Data is from World Health Organization, Global Observatory on Health R&D, via Springer, AdisInsight (2020). See Appendix, Table 2 for methodology and full dataset.
 There are many clinical trials attempting to repurpose existing antivirals. See Table 4 – New Development Programs for COVID-19. See also William Haseltine, Want to Prevent Another Coronavirus Epidemic? Scientific American (Jan. 29 2020), https://tinyurl.com/touk5r7 (“These enzymes are very similar to one another in all coronaviruses. This is a critical point. This common molecular pattern of all coronaviruses makes the challenge of identifying drugs to control coronaviruses less daunting.”)
 Some technologies funded by the public for MERS-CoV and other pathogens are being now used against the new coronavirus. See CEPI to fund three programmes to develop vaccines against the novel coronavirus (Jan 23. 2020), https://tinyurl.com/wqkzcq8.
 Unless otherwise specified, the source is World Health Organization, Global Observatory on Health R&D, via Springer, AdisInsight (2020). See Appendix, table 2 for methodology and full dataset.
 Coalition for Epidemic Preparedness Innovations, which includes funding from several national governments and foundations. Vaccitech licenses MERS rights to Oxford University (Sept. 29 2018), https://tinyurl.com/sbvsuth.
 Department of Defense and Coalition for Epidemic Preparedness Innovations. Inovio’s MERS Vaccine Generates High Levels of Antibodies and Induces Broad-based T Cell Responses in Phase 1 Study (June 27 2018), https://tinyurl.com/ucz2mvr.
 The development of a vaccine against MERS virus gets international support (Aug. 24 2018), https://www.dzif.de/en/development-vaccine-against-mers-virus-gets-international-support
 On February 5th, we compiled the list of technologies using several industry websites, including drawing from a table compiled by BioCentury. See Winnie Pong, Steve Usdin, A dozen vaccine programs under way as WHO declares coronavirus public health emergency, Biocentury (Jan. 30 2020), https://tinyurl.com/rloe6wz. We then reviewed the news media for new coronavirus development programs on or before February 5th. We considered support in research and development of medicines, including clinical trials, when determining public and private nonprofit support. For biotechnology companies and academic labs, we also considered whether they received any general operational funding from public and private nonprofit sources.
 A randomized, open-label study to evaluate the efficacy and safety of Lopinavir-Ritonavir in patients with mild 2019-nCoV pneumonia, Chinese Clinical Trial Registry, http://www.chictr.org.cn/showprojen.aspx?proj=48991.
 Johnson & Johnson Announces Collaboration with U.S. Department of Health & Human Services to Accelerate Development of a Potential Novel Coronavirus Vaccine (Feb 11. 2020), https://tinyurl.com/thx5p6s.
 A randomised, open, controlled trial for darunavir/cobicistat or Lopinavir/ritonavir combined with thymosin a1 in the treatment of 2019-nCoV pneumonia, http://www.chictr.org.cn/showprojen.aspx?proj=48992.
 See Inovio Selected by CEPI to Develop Vaccine Against New Coronavirus, (Jan. 23 2020), https://tinyurl.com/vteusjn. The DNA medicine platform was initially tested in a MERS vaccine supported by the DoD. Middle East respiratory syndrome coronavirus vaccine – GeneOne Life Sciences/Inovio Pharmaceuticals, AdisInsight (Feb 5. 2020), https://adisinsight.springer.com/drugs/800043325.
 Novavax JPM Presentation (Jan 16. 2020), https://www.novavax.com/20200116-JPM-Presentation.pdf
 The initial SARS and MERS vaccine work—which forms the basis for the COVID-19 work—was funded by NIH and the DoD. See Baylor College of Medicine, MERS-CoV Vaccine and SARS Vaccine, https://tinyurl.com/t4ya7p2 and https://tinyurl.com/qqteskv.
 See Zain Rizvi, By Any Means Necessary: How Allergan Gamed the System to Raise Drug Prices and Flood the Country with Pills, Public Citizen (2020). See also Lisa Schwartz et al., Medical Marketing in the United States, 1997-2016, JAMA (2019), https://tinyurl.com/y5hqbk82.
 Helen Branswell, Who will answer the call in the next outbreak? Drug makers feel burned by string of vaccine pleas, STAT (Jan. 11 2018), https://tinyurl.com/wvtelhu (“GSK has made a corporate decision that while it wants to help in public health emergencies, it cannot continue to do so in the way it has in the past.”).
 Stanley Plotkin et al., Establishing a Global Vaccine-Development Fund, 373 New England Journal of Medicine (July 23 2015), https://www.nejm.org/doi/full/10.1056/NEJMp1506820
 Médecins Sans Frontières, Open letter to CEPI Board Members: Revise CEPI’s access policy (Mar. 5 2019), https://tinyurl.com/scx7kay. CEPI has defended its new policy by saying it provides more flexibility.
 UCL Institute for Innovation and Public Purpose et al., People’s Prescription (Oct. 2018), https://tinyurl.com/yxhcgatt. (“Governments should not be limited to ‘fixing market failures’ – financing high-risk basic research where private investments are scarce and regulating high prices after they have been set. Instead they should be actively setting the directions for health innovation in the first place, in order to serve real public health needs.”)
 Tim Hubbard and James Love, A New Trade Framework for Global Healthcare R&D, 18 PLoS Biology (2004). See also, Aidan Hollis, The Health Impact Fund: A useful supplement to the patent system? Public Health Ethics, (2008), Dean Baker, Rigged: How Globalization and the Rules of the Modern Economy Were Structured to Make the Rich Richer (2016), UCL Institute for Innovation and Public Purpose et al., People’s Prescription (Oct. 2018), https://tinyurl.com/yxhcgatt, Dana Brown and Ameet Sarpatwari, A National Pharmaceutical Research and Development Institute (Nov. 4 2019), https://tinyurl.com/sungkn2
 Charles Silver and David Hyman, Here’s a Plan to Fight High Drug Prices That Could Unite Libertarians and Socialists (June 21 2018), https://tinyurl.com/y9vlq5la. U.K Labour Party, Medicines for the Many: Public Health Before Private Profit (2019), https://tinyurl.com/u4ux5w9.
 This should also be supplemented by additional funding for national and global public health preparedness.
 Ekaterina Cleary et al., Contribution of NIH funding to new drug approvals 2010–2016, 115 PNAS.
 Rahul Nayak et al., Public sector financial support for late stage discovery of new drugs in the United States. 367 British Medical Journal (2019).
 Aaron Kesselheim et al, The High Cost of Prescription Drugs in the United States, 316 JAMA 858 (2016).
 This includes “the actual realized gains from exercising stock options and the vesting of stock awards.” William Lazonick et al., Financialization of the U.S. Pharmaceutical Industry, Institute for New Economic Thinking (2019), https://www.ineteconomics.org/uploads/papers/Lazonick_financialization.pdf
 35 U.S.C. § 209, Licensing Federally Owned Inventions. Knowledge Ecology International, Joint Comments by KEI, UACT, Social Security Watch and Health Gap on the proposed NIH Exclusive License in CAR Therapy to Lyell Immunopharma (Sept. 19 2019), https://www.keionline.org/31713.
 David Quammen, We Made the Coronavirus Epidemic, NY Times (Jan. 28 2020), https://www.nytimes.com/2020/01/28/opinion/coronavirus-china.html.
 Based on unique project application serial number.
 World Health Organization, Global Observatory on Health R&D, https://www.who.int/research-observatory/monitoring/processes/health_products/en.
 The status column in the tables above reflect the development stage of each drug. The WHO database, based off the AdisInsight database, categorized each vaccine and medicine as active or inactive. Active products include those in research, preclinical studies and clinical trial phases I-IV. They also include registered and marketed medicines. “Research” refers to the earliest stage of development that includes bench lab analysis. “Preclinical” refers to a more advanced stage that involves animal testing. Inactive products include drugs whose research was discontinued or had no development, as well as drugs withdrawn from the market. “Discontinued” refers to drugs with studies that were explicitly suspended. “No development” refers to drugs with studies that did not report new findings for at least 2 to 4 years. The bracketed text refers to the last known active phase.